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What is Hormone Therapy for Menopause, Anyway?

Updated: May 22, 2023

I'm amazed at how many women are ready to jump on the bandwagon without even really understanding what hormone replacement therapy (HRT) really is.

What you need to know about hormone therapy for menopause

photo by Jernej Furman for Flickr

What is HRT? Hormone replacement therapy in menopause is medication that has as its goal to supplement or replace the hormone levels that the onset of ovarian failure has seen dropped. The three main hormones being replaced are oestrogen, progesterone, and testosterone.

The point of HRT is that you can stay in optimal health. Note that optimal health does NOT just mean that the obvious symptoms clear up, like the classic hot flashes, night sweats, and vaginal dryness. Ovarian failure, which is what menopause is, has many other affects on the body that don't produce such obvious symptoms at first. It affects the brain, the skin, your nervous system, your bones, your digestive system, the list goes on.

Note that HRT is not exclusive to those approaching or experiencing menopause. HRT can also be used for those who are intersex, transgender, or as in infertility treatment. Or by men who are experiencing low testosterone levels.

What format does HRT medication come in?

There are different 'kinds' of HRT, with the most updated and now seen as safest regime called 'body identical HRT'.

Older synthetic forms of HRT often came in pill format. But body identical HRT comes in gel capsules, transdermal gels you rub on your body, or patches that you stick on. In some countries like America you can also be given HRT in pellets that are inserted under your skin and give out hormones at regular intervals. And in some cases testosterone can be done by injections.

In France if you get hold of body identical HRT it will be capsules, gel, and/or patches. I was also actually once offered testosterone in injection form, but recognised it as the crazy advice it was (the doctor in question believed a high dose of testosterone 'kick started' a woman's sex drive for good. It doesn't).

Note in some countries you can also get 'bioidentical HRT' which comes in creams. But bioidenticals are not highly recommended for reasons I'll get into in another post. And it's not in France. Which is not surprising given that it is a very unregulated form of HRT and France doesn't generally allow unregulated medications.

HRT vs localised hormone replacement medications

The idea of HRT for menopause is to replace our dropped hormone levels at a dose that it affects our entire body. Which is very necessary, given that the drop of hormones we go through affects all sorts, from pretty much all of our internal organs, to our skin, to the way our brain functions. Such is the power of hormones.

It's important to recognise that real hormone therapy for menopause is high dose and a body-wide medication to avoid a mixup I commonly see happen. This being where women are given a localised hormonal medication, to deal with one or two symptoms in a certain area of their body. ANd then think 'they are on HRT'. Then suffer through other symptoms thinking this is as good as it gets.

An example is being prescribed a cream or pessary to deal with vaginal dryness and atrophy. Yes, it's a form of oestrogen. But it's a weaker form, and dose of oestrogen that only affects the local area. It does affect the rest of your body. Such medication will not stop hot flashes, night sweats, etc. And you can take such a medication alongside proper HRT.

Another such medication is progesterone cream for breast pain. Again, it is not the same as the HRT grade progesterone.

Will hormone therapy for menopause bring my hormone profile back to what it was before?

This is where the medical community fails women in my opinion. HRT is in some ways Russian roulette, if I may be so bold as to say. Why? Because women can vary wildly with their hormonal profiles. And by the time we get to menopause, it's too late for any doctor to really know what our healthy baseline was. Plus, our baseline will vary across each cycle.

To really be able to help us reach our optimal hormonal profiles? Women would need to have their hormonal profiles constantly checked. Particularly in their thirties before the onset of perimenopause. (And from what I can see this could help spot so many other health issues, but that's another story).

Without this sort of information, HRT is prescribed on a subjective over clinical basis. And by that I mean instead of using constant blood checks, or things like measuring how often you are getting hot flashes? You are given one blood test at most to compare you to a general average. Then are given HRT based on your self-described symptoms.

Once on a HRT regime, if you complain that you feel your symptoms are back, then your dose is adjusted. Mostly without any other test (except for when it comes to testosterone). It's as 'scientific' as that. You might even be prescribed HRT with no blood test at all, depending on things like your age, the reasons for this are described in another post.

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